National Health Insurance

National Health Insurance

National Health Insurance


National Health Insurance, government-operated system of insurance that provides financial benefits and medical services to people disabled by sickness or accident. National health insurance systems are found in many countries, particularly in Europe.

Systems of national health insurance frequently are coordinated with other national programmes of social insurance, such as pension programmes, programmes of unemployment insurance, and workers’ compensation.


The first country to provide health insurance on a national scale was Germany. The German Chancellor Prince Otto von Bismarck obtained passage of a compulsory sickness-insurance law in 1883, which was financed by a state subsidy. Various types of national health insurance were adopted by other European countries, including Austria-Hungary later in the 19th century, Norway in 1909, Sweden in 1910, and Great Britain and Russia in 1911. After World War II the growth of national systems of health insurance in Europe was extensive, although a number of benefits, conditions of eligibility, treatment of dependants, and provisions for maternity care varied widely.


The British system of national health insurance, comprising social security and the National Health Service, was thoroughly reorganized after World War II and is one of the most comprehensive systems in operation. National health insurance is under the jurisdiction of the Department of Health and Social Security, which administers the payment of cash benefits for sickness and maternity. All employed and self-employed people up to the age of 65 are eligible for benefits, and the funds for the programme are derived from weekly contributions by employers and employees. Sickness benefits are payable up to pensionable age if a sufficient number of weekly contributions have been made. Maternity benefits include weekly allowances, before and after confinement, to women who ordinarily work, as well as certain cash grants.

The National Health Service administers the National Health Service Act, which went into effect in 1948. The cost of the programme is met largely from public funds. Benefits, which are of unlimited duration, include hospital services, general medical services outside hospitals, and local health services. Hospital services are provided in general and special hospitals, for inpatient, outpatient, and day-patient care, including the services of specialists. General medical services include those of general practitioners and dental, pharmaceutical, and ophthalmic services. The local health services include maternity and child-welfare services, domiciliary nursing care, aftercare, immunization, and some mental-health services.

A person may use all the facilities of the National Health Service, or only a part of the service. He or she may, for example, make private arrangements with a practitioner for medical care and apply for free hospitalization. Practitioners are not required to participate in the programme. Those who participate and work outside of hospitals receive a fee for each patient as well as a basic practice allowance. Participating doctors may also engage in private practice. Almost all of the hospitals in Great Britain are administered by the National Health Service.

Controversial government reforms to the National Health Service were introduced in the 1980s and 1990s. These included the establishment of trusts, making NHS bodies self-governing purchasers of health care resources, and fundholding status for local practices, allowing general practitioners to manage and allocate their own resources. The overall aim was to bring the benefits of competition into the National Health service through an “internal market”, and to counteract bureaucratic inefficiency.